Provider Demographics
NPI:1154408235
Name:YOUNG, JERRY D (DO)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:D
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HOSPITAL CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-4772
Mailing Address - Country:US
Mailing Address - Phone:979-241-6100
Mailing Address - Fax:979-244-8103
Practice Address - Street 1:600 HOSPITAL CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-4771
Practice Address - Country:US
Practice Address - Phone:979-241-6100
Practice Address - Fax:979-241-6105
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4630208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122021206Medicaid
TX8F7562OtherMEDICARE ID - TYPE UNSPECIFIED
TX122021206Medicaid
TXF73337Medicare UPIN